Sunday, 10 July 2011

World Zoonoses Day: Only four per cent of medical students know about the diseases transmitted by animals to man

Syed Akbar
Hyderabad: Today is yet another World Zoonoses Day. And if you ask medical students and  fresh medical graduates to define the term, "zoonoses", you may get the answer accurately from only a  handful of them. Don't be surprised, just four per cent of our medicos and medical graduates know what  exactly the term, zoonoses, denotes in the medical context.
No wonder then, the World Health Organisation describes zoonoses as a "no man's area".  Medical doctors believe zoonoses is something which veterinary doctors should deal with, while  veterinarians think it's part of the job of physicians. And wildlife experts, whose role is nonetheless important, do  not venture into this grey area, believing that zoonoses is the headache of physicians and veterinarians. The  result is ignorance, death and heavy economic loss.
The Public Health Foundation of India, which conducted a survey of medicos and fresh  medical graduates
to find out how best they are informed about zoonoses, was shocked that 96 per cent of  the respondents
failed to define it accurately. Worse, 50 per cent of the students in private medical  colleges and 23 per cent
in government colleges could not link H5N1 (avian influenza) with birds.
Well, before you think that zoonoses is something from out of this world and the hardest  term to define, let's know what it stands for. Zoonoses (singular zoonosis) means the diseases transmitted by  vertebrate animals to man and vice versa. For instance, swine flu, rabies, HIV, plague, anthrax and Japanese  encephalitis.
Says Dr Muralidhar, senior veterinarian, "it's useless blaming our medicos and medical  graduates. Zoonoses is a neglected area, its importance in human and animal health notwithstanding. India  with 1.2 billion people does not have an advanced national centre for zoonoses research. Neither the  Central government nor State governments give importance to this area of study".
Ironically, even the Medical Council of India has not recognised postgraduate course in  infectious diseases, though they are known for regular outbreaks as in the case of novel human influenza or  swine flu. If most of our doctors fail to diagnose rabies and even if they diagnosed the disease do not know  that the person bitten by a rabid dog should be administered immunoglobulins and anti rabies vaccine, the fault  lies with the age- old medical teaching system and syllabus. It's this lack of knowledge about  immunoglobulins that had led to recent deaths due to rabies despite the victims being vaccinated.
Dr VM Katoch, director-general of the Indian Council of Medical Research, agrees that the  medical
syllabus should be "re-oriented" to suit the modern needs. "What we need in medical  syllabus is applied
studies like applied orthopaedics and applied microbiology," he added. 
As the PHFI survey reveals, 60 per cent of students in public medical colleges and just 20 per cent in
private colleges were able to correctly state all steps involved in the management of  rabies. During clinical
practice, 76 to 80 per cent of respondents did not think of zoonoses as differential diagnosis. Only 5.5 per
cent of respondents were able to identify rabies as a disease transmitted by animals other than dogs.
"It's true the zoonoses subject did not receive the attention it deserves. But now both  ICMR and Indian
Council of Agricultural Research are closely working on it. I have been meeting the ICAR  director-general
every three months on zoonoses," Dr Katoch pointed out.
Cooperation between practitioners of animal and human medicine is important as about 200  diseases fall
under the category zoonoses and it's mostly humans that suffer. And yet the medical curriculum is not
updated to keep students abreast of emerging diseases, infections and pathogens. "Zoonoses constitute
about 60 per cent of all known human infections and 75 per cent of all emerging pathogens," says a WHO
report.
"The government acts only when there are outbreaks like novel human influenza, while there's little research
on neglected zoonoses including rabies. Diseases transmitted through meat, poultry, milk and fish claim
lakhs of lives every year, and leave many others unhealthy. Brucollosis, which is transmitted through unpasteurised milk, for instance, causes infertility in people," says zoologist M Chakrapani.
According to World Health Organisation, about 75 per cent of the new diseases that have  affected humans
over the past 10 years have been caused by pathogens originating from an animal or from products of
animal origin. Many of these diseases have the potential to spread through various means over long
distances and to become global problems.
Yet the knowledge among medical students on all emerging and new infectious diseases is  poor. "The
average knowledge score was 64 per cent in the public medical college and 41.4 per cent  in the private
medical college. On an average, a medical student/graduate knows only 40-60 per cent of  what is needed by him or her in order to diagnose, treat, report and control zoonotic diseases  effectively," points out the PHFI study conducted by Dr Manish Kakkar and his team.
Stating that lack of awareness, weak surveillance systems, infections falling in ‘no  man’s land’ and absence of intersectoral approach are the major challenges in understanding zoonoses, the WHO  calls for active participation of multiple sectors - medical doctors, veterinary doctors and wildlife  experts, besides
government agencies.
Researchers argue that the importance of zoonoses can be gauged from the fact that new  pathogens and
diseases have evolved in recent times throwing up major health challenges for researchers  and health
planners. Added to this is the problem of drug resistance and emergence of superbugs.  Change in
environment and farming practices as also food habits create new health issues. While  veterinary colleges
observe world zoonoses day, medical colleges do not bother even to organise special  classes for students, leave alone public awareness.
With zoonoses failing to get the priority it deserves, many people do not even know that  they are suffering
from a zoonotic disease until the problem gets severe. This often proves quite dear, both  in terms of
economics and human and animal health. And if it is a zoonotic disease without known cure  - rabies,
Japanese encephalitis or HIV/AIDS - the ignorance always ends in death.
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* Ignorance about a zoonotic disease may often lead to death. When Crimean Congo Haemorrhagic Fever
struck Gujarat earlier this year, it claimed more number of medical staff than patients. Attending doctors
failed to diagnose the disease. Doctors even did not know the precautions they should take. Only after the
ICMR intervened did doctors know what the real problem was. But it was too late by then.

* The Public Health Foundation of India has suggested "one health" concept to bridge the gap between
medical and veterinary doctors on zoonotic diseases. There should be an organised efforts at the national
level.

* The government wakes up only when there are outbreaks of zoonotic diseases. It forgets the moment the
problem subsides. Research on zoonoses is quite poor.


* Some of the notorious zoonoses are swine flu, rabies, leptospirosis, Crimean-Congo hemorrhagic fever,
Japanese encephalitis, avian influenza, plague, anthrax, enterhaemorrhagic E coli, and bovine spongiform
encephalitis.

* Those at risk of contracting zoonotic ailments are old people, pregnant women, small children, and people with compromised immunity.

* With no clear cut demarcation on zoonoses authority, unscrupulous researchers have been claiming funds from both the Indian Council of Medical Research and the Indian Council of Agricultural  Research without actually doing any concrete work.

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